Can lifestyle measures, nutrition or medical interventions delay the onset of menopause in women?

Genetics is the strongest determinant of the age at menopause, but a handful of lifestyle and nutritional factors show consistent associations. This emerges from observational research, including a British cohort study in 3,566 women and an Australian cohort study in 1,146 women who were followed for an average of 12.5 years. Intervention studies in which women were randomly assigned to a lifestyle and then followed until menopause are almost non-existent. Everything we know is therefore based on associations, not proven cause-and-effect relationships.

Among nutritional supplements, fish oil had the strongest association with a later menopause in the British cohort study. Women who regularly took fish oil had a strongly reduced risk of early menopause compared with non-users (hazard ratio 0.05). A vitamin B complex, an antioxidant mixture and vitamin C also showed positive associations, but less pronounced ones. The same study found that smoking and eating a lot of red meat are associated with an earlier menopause. These are modifiable factors where the advice is clear: quitting smoking and reducing red meat consumption fit within a broader healthy lifestyle.

In the area of nutrition, beta-cryptoxanthin stood out -- a substance naturally found in mandarins, oranges and peaches. Women with a daily intake of approximately 400 micrograms of this substance experienced menopause on average 1.3 years later than women with a low intake, even after adjustment for other known factors. This is a single study and the mechanism has not yet been proven, but it suggests that eating more fruit may play a role.

Early menopause is not only a reproductive matter, but has broader health consequences. A very large Korean cohort study in more than 1.1 million women showed that women whose menopause began before the age of forty had a 13% higher risk of type 2 diabetes compared with women whose menopause began at age fifty or later. This is an observational finding, but it does lend weight to the potential importance of a later menopause for overall health.

Menopausal hormone therapy (MHT) cannot delay the onset of menopause itself, but a European expert guideline states that MHT has a beneficial effect on glucose metabolism and may delay the onset of type 2 diabetes in women after menopause. In women with diabetes and cardiovascular risk factors, a patch or gel containing oestradiol (administered through the skin) is preferred over an oestrogen pill. Safety and suitability must always be assessed individually by a physician. Furthermore, there is limited and inconsistent evidence that MHT in older women is associated with a larger brain volume, but randomised research is needed before any conclusions can be drawn from this.

Women entering the menopausal transition gain on average 2 to 14% more body fat, particularly in the abdomen. Finnish longitudinal cohort studies show that better nutritional quality and more physical activity are associated with less fat gain during this transition. Although this is not definitive proof that lifestyle delays menopause itself, it does suggest that a healthy lifestyle can limit the metabolic consequences of menopause. For delaying menopause itself, most interventions have not yet been sufficiently studied for safety and effectiveness, particularly for women who wish to become pregnant or who are breastfeeding.